Am J Psychiatry 162:1758-a-1759, September 2005
doi: 10.1176/appi.ajp.162.9.1758-a
© 2005 American Psychiatric Association
A View of American Psychiatry
JEFFREY L. GELLER, M.D., M.P.H.
Worcester, Mass.
To the Editor: On Dec. 18, 1831, a decade before the founding of the Association of Medical Superintendents of American Institutions for the Insane (now APA), Samuel Coleridge remarked, "If men could learn from history, what lessons it might teach us! But passion and party blind our eyes, and that light which experience gives is a lantern on the stern, which shines only on the waves behind us!" (1). Coleridge might equally have remarked on man’s failure to learn from histories of history. This latter misstep is one made in an article by Laura D. Hirshbein, M.D., Ph.D. (2). Although she dissected the APA presidential addresses themselves and cited works by historians, she ignored psychiatrists who, in APA-sponsored works, have provided insight into the very subject she ventured to explicate.
Perhaps most notable of Dr. Hirshbein’s omissions is the work of Walter Barton, the only psychiatrist to serve as both APA president at one point and its medical director at another (3). Barton established a basis for looking at the history of APA: perspective (ideas must be appreciated in the context of their time), pace (psychiatry moves forward in jerky motions, lead by pioneers who bring forward the main body), and cycles (old ideas are repeatedly revisited in the guise of novel thoughts). Dr. Hirshbein made substantial use of the first two principles; she ignored the third.
A second omission is the failure to cite the October 1994 issue of Hospital and Community Psychiatry (now Psychiatric Services). This edition had nine articles published in celebration of APA’s sesquicentennial, six by psychiatrists and one by a historian. Most relevant is an article titled "Issues in American Psychiatry Reflected in Remarks of APA Presidents, 1844–1994" (4). Taking the perspective of Barton’s third principle, this article demonstrates repeated themes throughout the presidents’ addresses as opposed to setting these addresses into historical theme periods. Neither approach is more or less legitimate, but the second one should surely acknowledge the first.
That APA itself revisits its own history is well illustrated by Callender’s final statement in his APA president’s address (5), the first official such address:
Its past at least is secure, and in duty to itself, it should preserve the just temper and moderation...and permit no internal dissension as to matters trivial, to deflect it from leading objects, and no external disparagement and denunciation, however ingenious or vehement, to discourage its purpose, or sow the seeds of its dissolution.
References
- Coleridge ST: Specimens of the Table Talk of the Late Samuel Taylor Coleridge. New York, Harper & Brothers, 1835
- Hirshbein LD: History, memory, and profession: a view of American psychiatry through APA presidential addresses, 1883–2003. Am J Psychiatry 2004; 161:1755–1763[Abstract/Free Full Text]
- Barton WE: The History and Influence of the American Psychiatric Association. Washington, DC, American Psychiatric Association, 1987
- Geller JL: Issues in American psychiatry reflected in remarks of APA presidents, 1844–1994. Hosp Community Psychiatry 1994; 45:993–1004[Abstract/Free Full Text]
- Callender JH: History and work of the Association of Medical Superintendents of American Institutions for the Insane—President’s Address. Am J Insanity 1883; 40:1–32
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